Provider Demographics
NPI:1144853482
Name:ESPINUEVA, ANNE LOU DIZON (APRN)
Entity type:Individual
Prefix:
First Name:ANNE LOU
Middle Name:DIZON
Last Name:ESPINUEVA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2012
Mailing Address - Country:US
Mailing Address - Phone:702-334-5518
Mailing Address - Fax:
Practice Address - Street 1:2545 S BRUCE ST STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-1778
Practice Address - Country:US
Practice Address - Phone:702-732-2438
Practice Address - Fax:702-737-5043
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-14
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV828875363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1144853482Medicaid